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Where is the best place to live as a psychiatrist?

When I get older, I want to move somewhere where there is less competition and a low cost of living? #college #career #psychology #healthcare #psychiatry

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Daniela’s Answer

Hi La´Nyah

The locations that Medscape rated as best for practice are, with only a few exceptions , the states with higher physician earnings, lower taxes, and fewer malpractice lawsuits — but that also have the largest numbers of uninsured people. The locations that Medscape rated as the worst for practice are, with only a few exceptions, the states with lower physician earnings, higher taxes, and more malpractice lawsuits — but that also have the fewest numbers of uninsured patients.

And I think this is a problem, because it suggests to its mostly physician readership (and to the broader public that may hear about it and get the wrong impression) that all physicians should care about is the money coming in and going out of their practices — without regard to the social, economic, and policy environment affecting the health of their patients.

Here is Medscape’s list of the top 10 best places to practice, and why, ranked in order:

1. Tennessee: low cost of living, good pay for physicians, progressive communities, music, and attractions
2. Mississippi: low taxes, low malpractice payouts, cultural activities.
3. Oklahoma: high physician income, arts and cultural community
4. Texas: no state income tax, choice of cities and geographies, fewer malpractice lawsuits, excellent medical community
5. Wyoming: many cultural activities, natural beauty, no state income tax, demand for physicians
6. Idaho: outdoor recreational activities, reasonable home prices, average tax burden
7. South Carolina: warm climate and warm people, several museums, good practice environment
8. New Hampshire: good physician compensation, low taxes, educated populace, proximity to Boston
9. Nebraska: below average cost of living, wealthy state, strong industry, good schools and low crime
10. Alaska: no income tax, adventurous lifestyle, wide scope of practice, tight-knit community

Here is their list of Medscape’s 5 worst places to practice, and why:

1. New York: with a special warning “to avoid New York City” because, “At $249,000, average physician compensation is more than $22,000 below the national average. New Yorkers know they pay a premium to live in the city, but they may not be aware of just how hefty it can be.”
2. Rhode Island: “RI physicians responding to the 2015 Medscape Physician Compensation Survey reported lower pay than any other doctors in the country.”
3. Maryland: “A high cost of living and too many doctors.”
4. Massachusetts: “High taxes, a high cost of living, exorbitant housing costs, and average physician compensation that is $23,000 below the national average.”
5. Connecticut: “It costs a lot to live there, and doctors don’t make a lot to compensate.”

What if practice locations were instead ranked by the fewest and the most numbers of uninsured patients? You end up with a very different ranking than Medscape’s:

The top 10 best states based on fewest uninsured (as % of population)

1. Massachusetts (4%)
2. Hawaii (5%)
3. Minnesota (7%)
4. Delaware (7%)
5. Vermont (8%)
6. District of Columbia (8%)
7. South Dakota (9%)
8. Rhode Island (9%)
9. Wisconsin (9%)
10. Iowa (9%)
11. Connecticut (9%)
12. New York (9%)
13. Kansas 10%)
14. Maine (10%)
15. Pennsylvania (10%)

(Nebraska and Maryland also have 10% of their population uninsured).

The bottom 10 worst states based on greatest number of uninsured (as % of population):

1. Texas (20%)
2. Nevada (20%)
3. Arizona (19%)
4. Florida (19%)
5. Wyoming (17%)
6. North Carolina (16%)
7. Georgia (16%)
8. New Mexico (16%)
9. Alabama (16%)
10. Alaska (16%)
11. South Carolina (15%)
12. Montana (15%)
13. California (15%)
14. Arkansas (15%)
15. Idaho (14%)

(Oklahoma and Mississippi are also tied with 14% of their populations uninsured.)

Why should the uninsured rate matter to physicians when considering the best and worst places to practice? Because “people without health insurance live sicker and die younger than those with insurance.”

What if one were to rank the states based on their overall performance on composite measures of accessibility and availability, prevention and treatment, avoidable hospital use and cost, healthy lives, and equity? The Commonwealth Fund did this, and also came up with a much different ranking than Medscape’s:

The top 10 best states based on overall health care performance are:

1. Minnesota
2. Massachusetts
3. New Hampshire
4. Vermont
5. Hawaii
6. Connecticut
7. Maine
8. Wisconsin
9. Rhode Island
10. Delaware and Iowa (tied)

The bottom 10 worst states based on overall health care performance are:

1. Mississippi
2. Arkansas
3. Oklahoma
4. Louisiana
5. Nevada
6. Alabama
7. Georgia
8. Texas
9. Indiana
10. Kentucky

(The next in order of worst to best are Florida, Tennessee, North and South Carolina.)


The complete article in:
https://www.kevinmd.com/blog/2015/06/the-best-places-for-doctor-to-practice-its-more-than-money.html

Best!
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